o.d. to
o.d.Ethics in OptometryA subject we all studied in school ­ but what
does it mean in the real world?BY NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O., Chief Optometric Editor

Our cover story this month is on professional ethics; a very important topic that does not get much coverage in our professional journals. Executive Editor Jim Thomas does a great job of bringing the topic to life with examples from current news events and by drawing upon recent federal legislation and policies adopted by professional associations.

For example, the trade association for pharmaceutical companies
(PhRMA, the Pharmaceutical Research and Manufacturers Association), recently adopted new policies that will affect how drug companies and contact lens companies interact with optometrists. Just as industry examines itself with this position paper, so should doctors.

Optometry has an excellent record of highly ethical behavior, which is commendable because we certainly face challenging dilemmas every day. Yet we can't allow ourselves to be complacent about ethics. We must strive to be introspective. While I certainly don't pretend to have all the answers, I'll be happy to supply some questions.

Real ethical dilemmas

Optometrists are in a unique situation as health care professionals, in that we profit from the sale of a product that we prescribe. Yet, we have mastered that balance so well for so many years, and because it has proven to be in the patient's best interest, it remains usual and customary practice. Do you think this practice is ethical?

HIPAA (Health Insurance Portability and Accountability Act) is bringing new policies about patient privacy and patient access to records. Do you think the legislation is taking patient rights too far?

There have been efforts in some states to restrict ophthalmic surgery co-management. Proponents raise ethical concerns that optometrists' interest in co-management is purely financial and that we seek to unduly control the surgeon's judgment. Is there truth in that? Do surgeons fight co-management for financial reasons?

As optometry endorses legislation to advance mandatory eye exams for
pre-schoolers, critics charge that we simply want to sell glasses to kids. We know this is false, but why do our detractors think that?

Closer-to-home dilemmas

Is it ethical for an O.D. to prescribe a certain contact lens because he gets a better deal on it? Or because he gets wined and dined by the sales rep? Or because that lens is harder for patients to obtain from other sources?

Does the answer to the last question above change if the "other sources" don't behave ethically in the first place? Is it okay for the end to justify the means?

Is it ethical to withhold a contact lens prescription, or make it difficult to obtain, if the doctor suspects the patient will buy lenses from an unethical source?

Is it ethical to attend seminars on medical insurance billing and coding, and to set fee policies and clinical procedures to maximize payments?

Is it unethical for doctors to think as business people do?

Walking a fine line

There is often a fine line between ethical practice and that which is morally suspect, but optometrists have managed that line very well, in spite of many very complex situations. I suspect we do that by focusing on what's best for the patient first. After that, most other things take care of themselves.